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Lack of standards and interoperability hobbles exchange of health data.

The Centers for Medicare and Medicaid Services paid out the equivalent of the gross national product of Costa Rica -- $23.7 billion -- to hospitals and medical professionals from 2011 through April 2014 to adopt electronic health records.

Despite this whopping federal investment in EHRs, the JASON advisory group, which usually works on national security matters, blasted the lack of interoperability of EHRs as a serious impediment to the exchange of health data between doctors, patients and hospitals in a report discussed Tuesday at the monthly Health Information Technology Policy meeting run by the Office of the National Coordinator for Health Information Technology.

The 2009 Health Information Technology for Economic and Clinical Health – or HITECH – provided funds to spur hospitals and doctors to use certified EHR technology, with initial payments in 2011. The underlying supposition is that EHRs have the potential to improve the quality of patient care and reduce health care costs. Clinicians -- including doctors, osteopaths, nurse practitioners, chiropractors and more -- are eligible to receive $44,000 over five years under the Medicare EHR incentive program, and up to $63,750 over six years under Medicaid, with a base payment of $2 million to hospitals.

Elisabeth Myers, policy and outreach lead at the CMS Office of E-Health Standards and Services, told the policy meeting that as of this April, payments went to 385,158 clinicians, roughly one-third more than the 229,268 who received incentives in all of fiscal 2013. She reported that 4,993 hospital -- or 91.35 percent of those eligible for the payments -- have received them.

P. Jon White, director of health IT at the Agency Healthcare Research and Quality, told the policy meeting the JASON study showed current lack of EHR interoperability stands as “a major impediment to the unencumbered exchange of health information and the development of a robust health data infrastructure.”

The JASON study called for development of national software architecture for health information based on openly developed application programming interfaces and open standards and protocols, which will provide a migration path from legacy and incompatible EHRs. White called on the Office of the National Coordinator for Health Information Technology to define a health IT architecture over the next year and mandate that EHR vendors are required to develop and publish APIs that support that architecture.